Provider Demographics
NPI:1346204203
Name:MARGOLIS, MICHAEL I (DO)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:I
Last Name:MARGOLIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4510 SHERIDAN ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3516
Mailing Address - Country:US
Mailing Address - Phone:954-893-8900
Mailing Address - Fax:954-893-8992
Practice Address - Street 1:4510 SHERIDAN ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3516
Practice Address - Country:US
Practice Address - Phone:954-893-8900
Practice Address - Fax:954-893-8992
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0004288207QA0505X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
82384OtherBCBS
171831OtherJMH
FL001969OtherNHP
3709520-006OtherCIGNA
FL06596200Medicaid
082539OtherAETNA
FL82384OtherBLUE CROSS
FLE32228OtherSUMMIT
FL065962200Medicaid
FLE32228OtherVISTA HEALTH PLAN
FLE32228OtherVISTA HEALTH PLAN
3709520-006OtherCIGNA
FLE32228Medicare UPIN